DCIS Management Since Publication Of Clinical Practice Recommendations: Surgeons' Practices And Women's Experiences
Funder
National Health and Medical Research Council
Funding Amount
$360,783.00
Summary
Ductal Carcinoma in Situ of the breast (DCIS) now represents 15% of all new cases of breast cancer. Although a benign disease, its diagnosis increases a woman's risk of developing invasive breast cancer and the goal of treatment is prevention of invasive disease. However the characteristics that predict this progression have not been clearly identified. Consequently women are confused about their diagnosis and both clinicians and women are faced with complex treatment decisions. The National Bre ....Ductal Carcinoma in Situ of the breast (DCIS) now represents 15% of all new cases of breast cancer. Although a benign disease, its diagnosis increases a woman's risk of developing invasive breast cancer and the goal of treatment is prevention of invasive disease. However the characteristics that predict this progression have not been clearly identified. Consequently women are confused about their diagnosis and both clinicians and women are faced with complex treatment decisions. The National Breast Cancer Centre (NBCC) published a set of eight clinical practice recommendations for the management of DCIS in September 2003 and a guide for consumers in 2004. Currently there is no information regarding how the treatment recommendations have been received by surgeons, the extent management of DCIS now follows these recommendations or the impact of the treatment recommendations on the medical experiences of women with DCIS. This project will fill this gap. The project aims to: 1. Examine the impact of clinical practice recommendations for the management of Ductal Carcinoma in Situ (DCIS) of the breast on clinical practice 2. Determine awareness of and attitudes towards the recommendations among surgeons treating DCIS and to examine the relationship between these attitudes and clinical practice 3. Examine women's experience of a DCIS diagnosis, their understanding of its prognosis and involvement in treatment decisions after release of a consumer guide in 2004 This research will determine whether the publication of the treatment recommendations in 2003 influenced the medical care women with DCIS recieve and identify the factors associated with surgeons and women that facilitate or prevent the uptake of these recommendations. This information will be used to develop strategies increase surgeons' adoption of the treatment recommendations in order to ensure that all women with DCIS have access to the best care possible.Read moreRead less
Perth Aboriginal Breast Feeding Study: Reasons For Not Breast Feeding And For The Early Cessation Of Breast Feeding.
Funder
National Health and Medical Research Council
Funding Amount
$207,237.00
Summary
Perth Aboriginal Breast Feeding Study : Reasons for not Breast Feeding and for the Early Cessation of Breast Feeding. Breastfeeding has many advantages for the nutrition and health of infants and mothers. Recent research has shown the importance of longitudinal studies of breast feeding and the importance of family support systems, especially the attitude of the baby's father. In urban Aboriginal families the rate of breast feeding is lower and the duration is shorter than for those living in ru ....Perth Aboriginal Breast Feeding Study : Reasons for not Breast Feeding and for the Early Cessation of Breast Feeding. Breastfeeding has many advantages for the nutrition and health of infants and mothers. Recent research has shown the importance of longitudinal studies of breast feeding and the importance of family support systems, especially the attitude of the baby's father. In urban Aboriginal families the rate of breast feeding is lower and the duration is shorter than for those living in rural areas. There have been no longitudinal studies exploring the factors involved in the initiation and the continuation of breast feeding by Aboriginal women. A sample of 440 Aboriginal women will be recruited from Perth maternity hospitals. After an initial interview the women will be followed up at monthly intervals to find out their progress with breast feeding. In addition a number of focus group discussions will explore attitudes of Aboriginal women and men to breast feeding. The outcome of the studies will be information to feed back to the community through Aboriginal organisations. It will provide the basis for specifically targeted health promotion programs to maintain and to improve breast feeding rates in the Aboriginal community.Read moreRead less
The Diamond Cohort Study- Examining Depressive Symptoms In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$570,886.00
Summary
Depression is the single largest cause of disability for people in Australia. It is mainly managed in general practice-primary care, yet many people experiencing depression go unrecognised by their family doctor or general practitioner (GP). Some people, even when given treatment, remain depressed. Guides on how to manage depression have been mainly based upon people attending psychiatrists and hospitals. In addition, there have been a number of large studies overseas testing new ways of helping ....Depression is the single largest cause of disability for people in Australia. It is mainly managed in general practice-primary care, yet many people experiencing depression go unrecognised by their family doctor or general practitioner (GP). Some people, even when given treatment, remain depressed. Guides on how to manage depression have been mainly based upon people attending psychiatrists and hospitals. In addition, there have been a number of large studies overseas testing new ways of helping people with depression. Unfortunately, they do not seem any better than usual care by a GP. We are currently funded by the NHMRC for diamond 1 to follow 800 people to investigate the factors from the patient's and doctor's point of view that are likely to aid recovery from depression, and to detail the way in which people are cared for in the primary health care system. There is increasing research showing that depression is a chronic and relapsing condition and that a one-year follow-up, whilst longer than most previous studies, will capture only a small glimpse of the health service use and relapse patterns of the patients enrolled in our study. In this application, we request funding to continue to follow participants. diamond 2 aims to explore the patient characteristics and health service use patterns of patients who experience persistent major depression with patients who experience a single episode of depression within a 3-year period. We will use the data gathered to develop models that predict recovery-relapse-persistence of depression. Such models will enable us to develop guidelines and design interventions that better target those at risk of continuing and disabling illness. This work will be of international significance and has the potential to influence the entire primary mental health care system and contribute to substantial system change.Read moreRead less
DESPATCH: DElivering Stroke Prevention For Atrial Fibrillation: Assisting Evidence-based CHoice In Primary Care
Funder
National Health and Medical Research Council
Funding Amount
$561,447.00
Summary
Non-valvular atrial fibrillation (NVAF) is a common heart condition associated with a major risk of fatal and disabling stroke. Inexpensive anticoagulant medication has been proven to reduce all-causes of death and stroke in patients with NVAF. Anticoagulant treatment for NVAF is substantially under-used resulting in avoidable patient deaths and disabling stroke. The National Institute of Clinical Studies of Australia summarised the large, unrealised benefit of anticoagulation, stating that 'eac ....Non-valvular atrial fibrillation (NVAF) is a common heart condition associated with a major risk of fatal and disabling stroke. Inexpensive anticoagulant medication has been proven to reduce all-causes of death and stroke in patients with NVAF. Anticoagulant treatment for NVAF is substantially under-used resulting in avoidable patient deaths and disabling stroke. The National Institute of Clinical Studies of Australia summarised the large, unrealised benefit of anticoagulation, stating that 'each year, for every 1000 patients with NVAF given anticoagulants, we can assume that about 25 fewer people will experience a stroke and 12 fewer will die from a stroke than would be the case if they were not given them'. Despite this realisation, there is a lack of evidence to support any strategy to improve the care of patients with NVAF. This study seeks to optimise the management of NVAF in general practice. The DESPATCH study will employ a rigorous randomised design to evaluate an innovative educational intervention intended to overcome barriers to the best management of NVAF. If successful, DESPATCH will inform policy and practice aimed at overcoming barriers to best practice for the large and growing number of people with NVAF to reduce the risk of fatal and disabling stroke.Read moreRead less
Trial Of Structured Support To Enhance The Role Of Non-GP Staff In Chronic Disease Management In General Practice
Funder
National Health and Medical Research Council
Funding Amount
$780,625.00
Summary
Chronic disease presents a significant burden to individuals and the health care system , contributing to both an increasing proportion of the work of primary health care practitioners and to health expenditure. A number of interventions have been shown to result in sustained improvement of health outcomes for people with chronic diseases, including: more effective use of non-physician providers of care and nurse case management; integration of self-management support programs with guideline bas ....Chronic disease presents a significant burden to individuals and the health care system , contributing to both an increasing proportion of the work of primary health care practitioners and to health expenditure. A number of interventions have been shown to result in sustained improvement of health outcomes for people with chronic diseases, including: more effective use of non-physician providers of care and nurse case management; integration of self-management support programs with guideline based treatment plans; more intensive follow up and registries that provide reminders and feedback. While some of these approaches have been pursued within the Coordinated Care Trials and the Enhanced Primary Care (EPC) program in Australia, the role of non medical staff within general practice in chronic disease care has not been systematically investigated. In 2001 the Commonwealth introduced a number of initiatives to support better quality of care for diabetes and asthma in general practice and $104.2 million over four years was provided for general practices in areas of high workforce pressure to employ more Nurses. The roles of the Practice Manager and Receptionist have received much less attention. They include faclitating access to care, supporting the delivery of quality clinical care by the practitioners through the provision of expert management services (primarily information technology, staff, financial and facilities management) to the practice. With recent government initiatives expanding the role of general practice in Australia, effective management structures and processes within general practices are vital. Non-GP general practice staff may be the means by which more effective chronic disease management can be achieved at a time of increasing workforce pressure. This project aims to evaluate the impact of a program in which non-GP staff are trained and facilitated to be involved in the management of patients with chronic disease.Read moreRead less